Routine surgeries could be delayed due to lack of blood, experts warn. Stocks are at around half their normal level and hospitals have been told they should be ready to implement emergency measures – possibly as early as this month – should the situation worsen.
This includes reducing the number of non-urgent elective surgeries such as joint replacements that require an adequate blood supply if a patient is bleeding profusely.
Around 6.5 million patients are already on waiting lists for such operations, and around 300,000 are waiting at least a year.
“The shortage means hospitals will have no choice but to postpone procedures as it is unsafe to carry them out,” says Professor Ian Roberts, one of the UK’s leading experts on blood loss, who works at the London School of Hygiene Tropical medicine.
In July, Health Secretary Steve Barclay issued an urgent request for blood donations, warning that stocks were half normal but insisting there were still “lots of supplies”.
Hospitals will be forced to postpone many routine procedures because they do not have enough blood supplies to perform them safely
In July, new Health Secretary Steve Barclay, pictured, urged people to donate blood to replenish supplies. Otherwise, NHS bosses will be forced to implement a blood shortage contingency plan
However, NHS Blood And Transplant sent a letter to UK hematology departments in the same month that seems to paint a more desperate picture. The correspondence, seen by The Mail on Sunday, spoke of “concerns about adequacy of supplies in the coming weeks” and urged staff to “remain ready to implement a blood shortage contingency plan”.
Another letter, sent on August 30, said blood levels remain “lower than we would like” but gave no timetable for crisis measures.
Further emails between NHS England and NHS Blood And Transplant said blood could be withheld from elective surgeries expected by the end of this month.
The NHS has an official traffic light system for dealing with low blood counts. Currently, the UK is in the ‘pre-amber’ stage, meaning there is just enough blood to meet demand. NHS workers are being advised to be cautious about wasting stock and try to hold back blood types which are most likely to be running out. The next tier is yellow when hospitals need to “reduce and prioritize” blood use.
But experts say an important tool that could help carry out procedures is being neglected in NHS hospitals. A drug called tranexamic acid reduces major blood loss by a quarter when given before surgery. The National Institute for Health and Care Excellence (Nice) recommends giving it to all patients undergoing major surgery, but doctors don’t offer it.
Last year, an audit of 152 NHS hospitals found a third of eligible patients were not offered the £2-a-dose drug. A report published tomorrow in the British Journal of Anesthesia suggests vaccinating all surgical hospital patients could prevent 15,000 major bleeds each year.
“It makes perfect sense for doctors and patients,” says Professor Roberts, one of the authors of the report. “It’s a cheap, low-risk procedure that will save tens of thousands of blood units and lives.”
Currently, around 13,000 Britons die every year as a result of severe bleeding during an operation. Prof Roberts adds, “Not only do more doctors need to offer tranexamic acid, but we want every patient undergoing surgery to know they can and should ask for it.”
It is injected into the muscle in your thigh or into a vein in your arm and works by blocking the release of compounds that stop blood from clotting. The drug has long been used to treat severe bleeding in traffic accident victims and women with extremely heavy periods. Studies also show that it is highly effective in preventing blood loss before wounds develop.
In the letter, sent out last week, NHS Blood And Transplant urged consultants to use tranexamic acid “before major surgeries” to save the blood supply. But Prof Roberts says “outdated” views about the drug’s safety may discourage some doctors from using it.
Older studies linked tranexamic acid to a slightly increased risk of life-threatening blood clots in the days following treatment. However, recent studies involving more than 40,000 patients have shown that these fears are unfounded. Other large studies have shown that vaccinating patients 20 minutes before common surgeries, including joint surgery, can reduce the risk of needing a blood transfusion by up to a third, without increasing the chance of a blood clot.
“Patients should at least have a choice,” says Prof. Roberts. “A blood transfusion can be traumatic for a patient, often with a long recovery time and several extra nights in the hospital. Too many doctors are unfamiliar with the latest evidence showing how safe and effective this drug is.’
Last year, The Mail on Sunday revealed alarming data showing that only five percent of accident victims who could benefit from tranexamic acid receive it from emergency doctors.
“Typically, doctors learn about drugs through pharmaceutical marketing campaigns, but because it’s an old, cheap drug, nobody talks about it,” says Prof. Roberts. “NHS hospitals need to make use of this if they are to find an easy solution to these terrible shortages.”
NHS Blood And Transplant said there were sufficient blood supplies for “current clinical needs”, adding: “The focus now is to halt the further decline in stocks as stocks reach the amber stage [hospitals] may delay operations.’
- Visit blood.co.uk to register as a donor and find your local blood clinic.
